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Home My WebLink AboutPermit Electrical 2004-1-7 (2) " 225 r ll'ln S'IREET . SPRINGFIEL ,OR 97477 . PH:(541)726-3753 . FAX:t(5 6~lI>ct as submitted has the fo1lOW~9 zorung, and does not reqUIre specIfic land use ELECTRICAL PERMIT APPUCATION approval (2., CityJobNumbercomzcO'-/-DOOI1 Date /-7-0L( Zoning L"D .. . "."rk'" ~_' . ._......-'"'_..~utb-- -.. ........V0,-~:t~.._..., ...,. 1. ,.~toCA.Ti{)'(jP:INST~rto.. .. '.' 3. 'i!COMPLE'1'1!:'FEESCHEDlJLEBELOWi';'::!:;'"5~: ',';, ':m;',~ !....__..,..........~~..........'I.lii""....Ir.~ ~.~....."'-..""..,oU1.I..-....~~ l.b~1-""","'._~,..,...'~ .,~p;.:;-:;,...;,;mtr~f\1Iy..$l'C-..._.. ,..:."yloUf\j:;~ ' ..~ ,...;;:l 30b S-- &,4vvle- hlf'^"- fL.) LEGAL DESCRIPTION I7n3ZWD JOB DESCRIPTION <;(-(LI/I.-c..e- ~L.DAI(\f~ 0/ .:)00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. :;\.~;-.... ,~~.;.:o:.;-". .~""","i'i' :,......~':"".,..":""~............~~,.;';.".;;....'>:>"F-,..:.'...,,-... 2. );.CQN:!'J<<Q1i..OlC'J.l'i.sr;tT~T1){TIO!jPNJ;; . Electrical Contractor A'~hDI'/5 OL:'d. .Arc.. Address :/1 75" LA/. L ~ .A ve , City iE''''t:l/i!'Y1e Q Phone 3'f3-72-'t 7 Supervisor License Number ~ S;z.. 0 - 5 Expiration Date / 0 / 0 t,/ / Constr. Contr. Number / 7 z.-S- 2...- Expiration Date t!) 2-/ t::) s Signature of Supervising Electrician (l~/?~~~ ownd.me IJ A-~[A-r.<::- ~V\ ~ ~ Address 30b') &f.drvIt" ~ City <:;. 'P,:::- ~ Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent Owners Signature: Inspection Request: 726-3769 A. frli:_R~~"id~ti:d~Sihs:'I;~~~M~i~Fmiil~~i~T.~td~eUi"n ;"~Wii[~~~= r1i~"':;;~iit-.,.~_.......-_a;r-,li"-".,,,g.,,'f!''';'>'--''-' JiCil. ,.~., "..,y-~,~~:~~ Service Included 1000 sq. ft. or less Each additional 500 sq. ft. or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 $ 19.00 $50.00 B. ~'S~=~m~:!{iifif;r1ii~Xt,{~il~~R~ffi~m;ri~ ~i'"",,,~,~~!;"-"-"~i~..1~":'!liIl:Z'I=,p,~,~j()'~~j.';"~"Il'~'*i~-"'-!;j'~ii::~ 200 Amps or less 20 I Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsIV olts Reconnect Only $ 63.00 $ 75.00 $125,00 $163.00 $375.00 I $ 50.00 50 c. ~Temp.Or'a~S'e~'f~efli~~~~mi!ffj1~. . m-.m_-._." ',_' ".~ .."",.,._.,-,. ~_.~~~~~~~ ,; -~~i!r3 1,lIfes'lOU 0 InstaUation'J:er~e\!RIoft,Rlffl8~f\ utili'" , 12ll'G~~J<Jr /idbpted '0'1 tn~\E''' Rfa setsCS~oo t~ll~~~~E\~,QWlp\inose n QA.f\ 952ffi 00 ,,~<<lt~~~.),lfil.p~ \t\fO~I~S nt tn8 fU~~.OO . ,~p., 9~~'PPil1011~~." ~<l.'tIltt~~~gf\~~:f\ DD . . ."N~, " ~ j . . "".." ''''~'''''"~.7f~,:jl.>'~''''. ...... _;a.:; _."'... .J.! "; "~i~~'ct.,~ -,-' ~~;:'-"""~ N~~.!l!a,1P;j!\IlI'E1te&~ri'~er Panel One Circuit $ 43.00 Each Additional Circuit or with Service or Feeder Pennit $ 3.00 ~p~ingati~on II EXPIRE \~ TI-ll= WlJmI,OO !l~lllnMi.llltJ ~!\1HIS p@MIi ll> ~~~.OO 1MbTtl:IOOI;g~~ IS~\)ANDONF() fOf\S 25.00 rGt9MM ~ m~&.I. . $ 45.00 Minim&l:i't~~~ic ermit Inspection Fee is $45.00 + Surcharges ~~; ,.,.,. .".--..'.'.;.".....:':,.~. ~...,;.;...,~:;t;.~"..7..:~::...,....~..~ :;:r.'P..:ti';.'i. -'~::~~.':~lS:t." "~,._''''~~ 4. .t.SUBTOT.AI;.OF ABOvE,\)i'~~;:,$~,~."";;;;t'i<, ~~~~~.~.__,~,...:.F~~~~_._-,;;.";~.:;......J5:lt;;;tiii:::;~g~;1f,~g;"'~. 50 JSo soo 58 :)0 7% State Surcharge 10% Administrative Fee TOTAL Shared Drive(T:)IBuilding FormslElectric.a.l Pamit Application {"()3.doc Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line . . CITY OF SPRINGFIELD' Building/Combination Permit PERMIT NO: COM2004-00019 ISSUED: 01/08/2004 APPLIED: 01/07/2004 EXPIRES: 07/08/2004 VALUE: I SITE ADDRESS: 3065 GAME FARM RD ASSESSOR'S PARCEL NO.: 1703220001500 Springfield TYPE OF WORK: Electrical Work Only TYPE OF USE: New Residential PROJECT DESCRIPTION: Service reconnect Owner: WALLACE DUNKS Address: 3065 GAME FARM RD SPRINGFIELD OR 97477 I CONTRACTOR INFORMATION I License 17252 Expiration Date 02108/2005 Phone 541-343-7297 Contractor Type Electrical Contractor REYNOLDS ELECTRIC # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction Type: # of Bedrooms: SETBACKS Front yard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: Street Improvements: Storm Sewer Available: Special Instruction: Notes: Description I BUILDING INFORMATION I # of Stories: Lot Size: R-3 Height of Structure Sq Ft 1st Floor: Type of Heat: Sq Ft 2nd Floor: VN Water Type: Sq Ft BaijIWnt: Range Type: teqMlFf lIfilrtl~~arport Energy Path: Otegon \a.'tol ~~'OlII~rtG~\ l\lI~N~~~~rlO~~e~..~~~~~u\l/9~~~i~face Area: I DEVELOPM~T~NE~f-'fIQN-\f\I'o~~T\ ';;, \\'1'8 t\l\'8S · . '\0"/'.09S2..1:)V' - \e.\n co~\es e \eleR~nW:D PARKING ~"p e.'1 0'0 NO\e'. \\'1 ~at\6 Overl~t .~:'{OU tl\ cen\et. ~ \,)\\\\\'1 NO 'fotal: # Stre~ re,~~:\'Ie e Otegon 3Z.Z344Handicapped: Paved DriPe ~( tot \\'1 i" 1_eOO.3 Compact: nO, - ",~",,~"'f % of Lot Coverage: I PUBLIC IMPROVEMENTS I CE' Sidewalk Tpe: Elf 1\-1E WORK ~~:~~~~6~!~B\~~~~gf~:01 COl'-Al';\toNCot~ PERIOO. r,N'i 18 I Valuation Descriotion I $ Per Sq Ft or multiplier Square Footage or Bid Amount Type of Construction Value Date Calculated Total Value of Project Paee I 00 . . CITY OF SPRINGFIELD. Building/Combination Permit PERMIT NO: COM2004-00019 ISSUED: 01108/2004 APPLIED: 01107/2004 EXPIRES: 07/08/2004 VALUE: Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line I Fees Paid I Fee Description + 10% Administrative Fee + 7% State Surcharge Service Reconnect Amount Paid Date Paid Receipt Number $5.00 $3.50 $50.00 1/8/04 1/8/04 1/8/04 1200400000000000020 1200400000000000020 1200400000000000020 Total Amount Paid $58.50 I Plan Reviews I To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following work day. I Renuired Insnections I I Electric Service: Approval required prior to utility company energizing service. By signature, I state and agree, that I have carefully examined the completed application and do bereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described berein, and that NO OCCUPANCY will be made of any structure without permission of the Community Scrviccs Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time, that each address is readable from the street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractors Signature Date Paee 2 of2 '" 225 Fifth Street Springfield, Oregon 97477 541-726-3759 Phone Job/Journal Number COM2004-00019 COM2004-00019 COM2004-000 I 9 Payments: Type of Payment CreditCard /' inJii ~..,... ~. .;:.- Receipt #: 1200400000000uVIJu..0 Description + 7% State Surcharge + 10% Administrative Fee Service Reconnect Paid By ELLEN REYNOLDS Received By djb Check Number Batch Number Authorization Number 000271 008229 City of Springfield Official Receipt. Development Services Department Public Works Department Date: 01/08/2004 7:52:53AM Amount Paid Item Total: 3.50 5.00 50.00 $58.50 How Received In Person Payment Total: Amount Paid $58.50 $58.50 . .